Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Appropriations Issues

The House approved and sent to the Senate H.R. 2055, the FY 2012 Military Construction/Veterans Affairs appropriations bill, which provides the VA with $128 billion (a $2.4 billion increase over last year).  During consideration of the legislation, the House voted 402-1 to reject splitting the VA portion from the military construction portion of the legislation.  However this move is expected to be repeated with other spending bills.  The House also passed H.R. 2112, the Agriculture/Rural Development/FDA spending bill for FY 2012, on a 217-203 vote with Democrats objecting to spending reductions, especially for the FDA.  This week the House is scheduled to take up H.R. 2219, the FY 2012 Department of Defense Appropriations Act containing significant funding for defense health programs.

Federal Debt Limit Negotiations
The bipartisan/bi-chamber budget negotiators led by Vice President Joseph Biden met three times last week and an Obama/Biden/Boehner/Kasich “golf summit” on Saturday could help move up the timetable for an agreement expected to top $2 trillion in deficit reduction over ten years.  The Vice President said negotiators have discussed the entire federal budget and have reached agreement on a number of spending cuts, including changes affecting federal workers, but Rep. Chris Van Hollen said that nothing is agreed to unless the group comes together on other big ticket items, including entitlement program changes.  Congressional Democrats are skeptical of including Medicare changes and hope to keep opposition to the Ryan Medicare “premium support” proposal front and center for the 2012 elections.  Backtracking somewhat, Rep. Paul Ryan said he is open to changes in his proposal.  Keeping up the pressure for Medicare changes, 44 Senate Republicans sent a letter to the President reminding him that federal law requires the Administration to submit a plan to bring Medicare into balance, given the Medicare trustee report that the program has significant funding shortages.  Democrat Senators Harkin, Murray, Schumer, Stabenow and Whitehouse responded with a letter to Senate Minority Leader Mitch McConnell suggesting that any changes avoid Medicare benefit cuts and instead follow along the lines for delivery reform already adopted under the PPACA.  The Biden group also has the benefit of MedPAC recommendations that would shift high-cost Medicare beneficiaries to managed care plans and that would streamline copayments and deductibles under Part A and B.  It is expected that Medicaid spending reductions may lead the extent of any entitlement reform changes, with Republicans and governors calling for an end to the PPACA Medicaid eligibility “maintenance of effort” mandate.  House Democrats have also offered up an idea under H.R. 2190 to require Part D drug manufacturers to provide prescription rebates to Medicare/Medicaid dual eligibles.  Beginning in 2013, such rebates would be equal to the difference between the average rebate to private Part D drug plans and 23.1% of a drug’s average price.

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